The Vaccinators: Smallpox, Medical Knowledge, and the 'Opening' of Japan (review)

In December 1979, the World Health Organization announced that for the first time an acute infectious disease, smallpox, had been completely eradicated from the human population—the direct result of a worldwide campaign for vaccination. Ann Jannetta's The Vaccinators explores the first fifty years of this transnational endeavor and inserts Japan into the story of the aftermath of Edward Jenner's success in 1796 in demonstrating the immunizing effects of cowpox pus for smallpox. There is much to admire in this book. Jannetta has adeptly mined the immense secondary literature on smallpox and narrates economically but compellingly how doctors, civic-minded private citizens, diplomats, officials, colonial administrators, missionaries, merchants, and others cooperated in the transfer of medical knowledge about the vaccine and, more crucially, of the fragile biological material that was required to act upon that knowledge. The result of this unprecedented and ad hoc experiment in international public health was that within a decade of Jenner's publication of his findings, vaccination was being practiced throughout Europe, in the United States, in the Spanish colonies of Central and South America and the Philippines, in parts of China, and in the Dutch colony of Jakarta.

Jannetta makes good use of the case of Japan, which deviated from the pattern of rapid transmission, to explore in comparative terms the political, social, and institutional impediments that can hinder the transfer of knowledge, even of new technologies like the smallpox vaccine, the benefits of which seem beyond question. As she explains, although information about the vaccine reached Nagasaki as early as 1803, brought by Dutch or American merchants, it was almost fifty years before vaccination began to be performed in Japan. Why did information about the vaccine fail to be acted upon initially, and what happened over the course of the first half of the nineteenth century to change that? These are the questions at the heart of Jannetta's analysis. She argues that the crucial factor in the initial "failure" was not political or cultural resistance to the new technology, but rather the absence of the institutional structures that had fostered modern medical culture in Europe: the universities, medical and scientific journals, and professional societies that created a forum for the exchange of information.

Chapters 5 and 6 focus on documenting the formation of something akin to this modern medical culture in Japan between 1803 and 1849, the year when the first vaccinations were performed in Japan. The topic of vaccination has been a favorite in recent years among historians working on what has been termed "grassroots Rangaku." Jannetta critically engages with this body of often frustratingly "local" histories to produce a narrative that successfully places the Japanese encounter with vaccination in an international context. She argues that information about vaccination spread gradually among a group of ranpō, or "Dutch method," doctors who began to work cooperatively with each other, with Dutch merchants at Nagasaki, and with sympathetic daimyo to import the vaccine from Batavia. Behind this unprecedented collaborative effort lay the excitement generated by the idea of the vaccine and its promise to curtail the human costs of smallpox. Jannetta aptly characterizes the vaccine as a "transformative technology" (p. 186) and argues that in Japan, as in Europe, the vaccine's potential inspired the breakdown of social and geopolitical borders and allowed for the forging of new networks and new institutions.

Jannetta's work is an important contribution to the literature on early modern Japan and succeeds admirably in challenging the already tattered "closed country" image of this era. Like Ellen Gardner Nakamura's Practical Pursuits: Takano Chōei, Takahashi Keisaku, and Western Medicine in Nineteenth-Century Japan (Harvard University Asia Center, 2005), The Vaccinators reveals the profound social significance of new medical knowledge in the first half of the nineteenth century. That said, I have two problems with the book. The first concerns the decidedly Whiggish cast of Jannetta's narrative. For her, "the vaccinators" are clearly the heroes...